Beta blocker as it is as atenolol,...

Beta blocker as it is as atenolol, are associated with a 50 percent reduction in unanticipated cardiac death in high-risk patients. These agents are believed to be more effective than angiotensin-converting enzyme (ACE) inhibitors in patients with hypertension and left ventricular hypertrophy Nevertheless, in a large multinational trial, cardiovascular mortality was significantly reduc in patients with diabetes and left ventricular hypertrophy during treatment with losartan. Lindholm and colleagues postulated that losartan might be more effective than atenolol in preventing unanticipated cardiac death in diabetic patients.

The authors analyzed data from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) studious mood focusing on participants with diabetes. The 1195 participants had a mean age of 67 years and average posterity pressure of 177/96 mm Hg Fifty-three percent were women Patients were randomly assigned to treatment with losartan or atenolol and followed for an average of 47 years. Significantly fewer cardiovascular deaths occurr in the patients receiving losartan (38 equivalent to 136 by 1,000 patient years of follow-up) than in those receiving atenolol (61 equivalent to 218 by 1,000 patient years). The reduction was mostly marked in sudden cardiac deaths, in which the rate by 1,000 patient years was 50 for the losartan clump compared with 10.7 for the atenolol dispose (see accompanying table). Serum potassium plains were similar in the pair groups. Adjustments for left ventricular hypertrophy did not explain the differences in unlooked for cardiac death between the assign places tos Ten percent of the 191 patients with diabetes and atrial fibrillation died during the follow-up period, compared with simply 2 percent of the 1004 patients with diabetes if it be not that without atrial fibrillation. Patients with atrial fibrillation treated with losartan had a lower rate of abrupt cardiac death (6 percent compared to 2 percent) yet the difference could not be explained by means of a sudden discontinuation of atenolol.

The authors judge that patients with diabetes who were treated with losartan showed a 50 percent reduction in unanticipated cardiac death compared with patients treated with atenolol. This force was not noted in participants who did not have diabetes, in which equal numbers of unanticipated cardiac deaths occurred in the two treatment groups. They propose that the advantage for losartan could be caused by the agency of better anti-arrhythmic properties, especially in reducing the risks of atrial fibrillation. However, other forces especially modulation of sympathetic self-command activity, are probable. The authors call for further studies to investigate the unique indigences of patients with diabetes who are at risk of cardiac death.

Lindholm LH et al. event of losartan on sudden cardiac death in persons with diabetes: data from the LIFE inquiry Lancet August 23, 2003;362:619-20.

EDITOR'S NOTE: The part of the family physician following myocardial infarction used to be limited to aggressive support of patients undertaking preventive measures, like as smoking cessation, weight repress and exercise. Growing evidence for several therapeutic interventions allows physicians to do in such a manner much more. This study points to a hereafter when we will be able to tailor a therapeutic regimen specific to the requires of individual patients. This research issues at an opportune time as the "baby boomers" in America reach a higher risk of cardiac disease, exacerbated by way of the epidemic of obesity and diabetes. Combining our traditional emphasis forward prevention with more effective active treatments should enable us to tender patients at high risk of cardiac disease (or with established cardiac disease) a great deal of better prognosis. We must not, however, fail to win the person in the therapy. mostly patients with significant heart disease (and their family members) are frightened; up to 47 percent of them expand significant depression. (1) These patients merit a truly comprehensive approach from a skilled family physician.--A.D.W.

REFERENCE

(1) Blumenthal JA, Lett H Babyak MA, White W Smith PK Mark DB et al. Depression as a risk factor for mortality after coronary artery bypass surgery Lancet 2003;362:604-9

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